The Imperative to Make All Patients Feel Respected and Comfortable

Aasim Padela, MD, MSc, is an emergency medicine physician, health services researcher and bioethicist whose scholarship focuses on the intersection of minority health and bioethics through the lens of the health care experiences of American Muslims. An assistant professor of medicine at the University of Chicago, he is director of Initiative on Islam and Medicine and faculty at the Maclean Center for Clinical Ethics. Padela was a Robert Wood Johnson Foundation Clinical Scholar from 2008 to 2011. His most recent work examines health care accommodations requested by American Muslims that can improve their experiences in the health care system.

Treating patients with understanding and respect is fundamental to health care. As the field has become increasingly focused on metrics and outcomes, we have learned that how comfortable and respected patients feel directly impacts their health outcomes. If you feel uncomfortable with your physician, you are less likely to seek their help, discuss your health concerns with them, or follow their recommendations.

Cultural competency and health care accommodations can help ensure that patients feel as welcome as possible as they seek health resources. While we seek to accommodate patients based on language and culture, we often overlook the ways a shared religion may influence the health of people from different ethnic, racial and socioeconomic groups. My research has looked at how we can improve the quality of health care American Muslims receive, particularly through means that account for their shared religiously-informed health care values and experiences. American Muslims are indeed a fast-growing, under-studied and underserved minority.

What we’ve learned provides some actionable steps that may improve health care not only for American Muslims but also for other populations. Our work also points to the need for more research focused on how a shared religion and religious identity impacts community health, and for the health care field to consider larger issues about how we track and deliver health services.

In this study, we set out to identify accommodations that American Muslims feel would improve their care. Working with community groups in the greater Detroit area, home to one of the nation’s largest Muslim communities, we recruited participants to share their experiences in the health care system and their views on what could make it better. Not surprisingly, given the social and political climate post 9-11, participants said that they feel stigmatized. If they try to maintain their religious identity in a health care setting, they fear they may open themselves up to discrimination or bad experiences. As one said, “If they see a nun walking through the hospital, they say… ‘Hi, Sister,’ but they see a Muslim woman in a hijab... they might be thinking they need to keep security on hand.”

When asked what could make their care better, participants raised three requests frequently. The first was gender concordance, having health care providers of the same sex. Participants placed great value on modesty and privacy drawing from Islamic teachings around gender relations, dress code, and family values. When gender concordance is not possible, participants suggested alternatives, such privacy screens, more modest gowns, and a policy of knocking before entering rooms. These accommodations may well benefit the general population. Many women are more comfortable having a pelvic exam performed by a female doctor, for example, and most would welcome a hospital gown that is more modest.

The second request was for halal food. Halal food is food that adheres to Islamic dietary regulations, and includes provisions such as the exclusion of pork. Preferring to eat food that is familiar, especially when you are ill, is understandable. But participants also felt that halal food was important for the healing process, that the food itself was health-giving.

The third accommodation requested was a neutral space for prayer, where Muslims could feel secure and comfortable. Muslims are obligated to pray five times a day, requiring a space that is clean and quiet. Providing a space that is free of any religious icons would be more welcoming, not just to Muslims to but to anyone of a different faith.

The findings of our study suggest that, while hospitals have traditionally recognized the need for food accommodations and religious spaces, they may not be keeping up with the needs of the communities they serve. Hospitals would benefit greatly from using tools that help them gauge these needs.

We also need to consider updating our data collection strategies to account for religious affiliation. Collecting data on the religious affiliation of the patients coming to hospitals, within health care systems and within national surveys and databases would be a major shift, and potentially an uncomfortable one, but may allow for targeted services such as spiritual care and food resources in hospitals based on the needs of the community it serves. Further, by allowing for comparisons across religious groups, we may be able to add a new dimension to health care disparity research and assess whether there may be some health concerns and obstacles members of one religious community face that others do not. Being able to test these associations would put us in a better position to create informed health interventions. Meeting the religious needs of patients may be a means to improve the quality of health care they receive.